Frowning George on a weak dollar

As home health providers await a proposed home health payment rule, U.S. senators introduced a bill Thursday morning that would protect them from Medicare cuts amounting to billions of dollars over the next decade.

Sens. Susan Collins (R-ME) and Debbie Stabenow (D-MI) introduced the Preserving Access to Home Health Act of 2023. The bill would block a so-called permanent behavioral adjustment of -7.85% to the home health program by the Centers for Medicare and Medicaid Services. Such a cut translates to more than $18 billion over the next 10 years, according to the National Association for Home Care & Hospice. The bill also would stop CMS from enacting a so-called temporary behavioral adjustment, which may take effect as soon as next year and could total $3 billion. 

“We’re all very much bracing for additional cuts,” Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, told McKnight’s Home Care Daily Pulse. “The remainder of the permanent adjustment could be outlined in the proposed rule as well as how CMS intends to implement the temporary adjustment, which certainly is alarming our congressional allies, which is why the bill was introduced before the rule comes out. We shall see what happens … but we and our congressional advocates certainly are concerned.”

Last October, the CMS enacted the first half of the permanent behavioral rate cut — 3.925%, amounting to $635 million — in 2023 with plans to instate the second half, another 3.925% cut, in 2024. The adjustment is based on perceived savings from the 2020 shift to a Patient-Driven Groupings model (PDGM), though home care leaders believe CMS’s methodology is flawed

Other leaders believe passage of this bill is crucial for the future of Medicare home health.

“We strongly support this essential legislation as current policy positions of CMS put access to home health services for the over 3 million beneficiaries that utilize this care in jeopardy,” NAHC President William Dombi said in a statement. 

The bill is another iteration of the Preserving Access to Home Health Act of 2022, which was introduced by both houses of Congress last year but not passed. Besides halting rate cuts, the legislation directs the Medicare Payment Advisory Commission, which advises Congress, to review and report on aggregate trends under Medicare Advantage, Medicaid and other payers, and consider the impact of all payers on access to care for Medicare home health beneficiaries. Dombi and Cunningham believe that Medicare should not be the target of cuts as it helps to subsidize underfunded Medicaid and Medicare Advantage. 

NAHC reminds legislators that the Congressional Budget Office predicts that Medicare home health spending is expected to drop from $18 billion to $16 billion this year and to $15 billion in 2024, 2025, 2026 and 2027. Also, nearly 95% of beneficiaries of Medicare indicate that home care is preferable to nursing home admittance following hospital care. Limiting home care access may result in increased hospital stay lengths, and the Medicare Trust Fund saves millions of dollars annually from the work of home health services.